Preparing for a Safe Pediatric Psychiatric Patient Admission

by Tamara R. O’Connor, RN

Purpose

Lack of inpatient pediatric psychiatric beds leaves patients boarding in emergency departments for extended periods of time. Patients can board for several days awaiting placement in a psychiatric facility. The purpose of this project was to provide a tool to guide pediatric acute care charge nurses in the safe admission of pediatric psychiatric patients to non-psychiatric acute care units when deemed appropriate by a multidisciplinary team.

Background

Fifty psychiatric inpatient beds are needed for every 100,000 people in the United States. Yet, we currently have only 11 beds/100,000 people.  That is a shortage of roughly 20,000 beds in California alone. Forty-five out of 58 counties have no pediatric psychiatric inpatient beds. Deinstitutionalization and notoriously low reimbursement rates have led to the closure of 43 psychiatric facilities in the state of California between 1995 and 2011.  That is a loss of just under 2700 beds.

Methods

Two multidisciplinary committees convened monthly to create an institution-wide tool to guide acute care charge nurses in the safe admission of psychiatric patients.  The process begins with a safety huddle, which yields a multidisciplinary plan of care.  The tool checklist guides appropriate members of the multidisciplinary team to flag the electronic chart and establish a safe room to admit the patient when deemed appropriate. 

Baseline data was collected to measure the acute care charge nurses’ understanding of the purpose of the tool and the protocol to call a safety huddle, flag a chart, and establish a safe room. The safe room checklist was then presented at four recurring charge nurse meetings on two acute care units with a total of 72 beds.  The survey was redistributed after each presentation for follow up assessment.

 

Results

At the inception of the project, only 10% of acute care charge nurses were aware that the safety huddle was an available tool to facilitate the admission of pediatric psychiatric patients. The first follow-up data demonstrates that almost 70% of acute care charge nurses are aware of the safety huddle and its purpose. Knowledge of FYI chart flagging improved by 25%, with opportunity for continued education. Data illustrates a 54% increase in the knowledge of charge nurses regarding safe room set up.

Discussion

While the data reveals room for continued education, the results are very encouraging.  Creating a safe room is a complex process that involves communications with Clinical Engineering, Facilities and Information Technology to both create a safe room and return it to its original state.  This process requires a fair amount of time and resources.  With the implementation of this process, we accomplish this in a matter of hours and are working to extend this same efficiency to night and weekend hours, where appropriate.

Moving forward, we look forward to hiring an advanced practice mental health nurse to provide education and to partner with administration to develop protocols for safe patient care.  We are also exploring more efficient ways to create permanent safe rooms that can easily transition to standard rooms using portable equipment.